tbuckley/cabot-search huggingface dataset:
Abstract 13206: Clinical Characteristics, Risk Factors, and Medication Use of Patients Under 50 Presenting With Stemi
Authors: Ayman Haq, Evan Walser-Kuntz, Gretchen A Benson, Michael Miedema
Journal: Circulation (2022)

Objective: To examine the clinical characteristics and risk factors of patients with ST-elevation myocardial infarction (STEMI) &lt;50 years old. Methods: All patients aged ≤ 50 years from March 2003 to June 2021 were enrolled from the prospective Minneapolis Heart Institute Level 1 STEMI database. Patient demographics, risk factors, comorbidities, medications use, illicit drug use, and lipid panel were analyzed by gender. Results: 908 patients were enrolled in the study (79.7% male, 88% Caucasian) and a minority had prior coronary artery disease (CAD) (Table 1). Risk factors included tobacco use (69%) and a family history of CAD (47%). Illicit drug use was rare (Table 2). Use of preventive medications was infrequent, including in those with established risk factors (Table 3). Median lipid levels were only mildly abnormal (Table 4). Conclusion: In younger patients with STEMI, smoking remains highly prevalent, rates of preventative medication use are low, and lipid levels alone may not effectively provide risk stratification.
Abstract 13172: Systematic Dissection, Preservation, and Multiomics in Whole Human and Bovine Hearts
Authors: Jesse D Moreira, Adam C Gower, Liying Xue, Yuriy Alekseyev, Karan K Smith, Seung H Choi, Nir Ayalon, Melissa G Farb, Kenneth Tenan, Ashley LeClerc, Daniel Levy, Emelia J Benjamin, Marc Lenburg, Richard N Mitchell, Robert Padera, Jessica L Fetterman, Deepa M Gopal
Journal: Circulation (2022)

Introduction: We developed a rigorous, systematic protocol for the dissection and preservation of human hearts for biobanking to advance our understanding of cardiovascular diseases (CVDs). Existing cardiac biobanks consist largely of biopsy tissue in select diseases and are insufficient for correlating whole organ phenotype with clinical data. Methods: We demonstrate optimal conditions for multiomics interrogation (ribonucleic acid (RNA) sequencing, untargeted metabolomics) in hearts by evaluating the effect of technical variables (storage solution, temperature) and simulated postmortem interval (PMI) on RNA and metabolite stability. We used bovine (N=3) and human (N=2) hearts fixed in PAXgene or snap-frozen with liquid nitrogen. Results: Using a paired Wald test, only two of the genes assessed were differentially expressed between left ventricular samples from bovine hearts stored in PAXgene at 0 and 12 hours PMI (FDR q &lt; 0.05). We obtained similar findings in human left ventricular samples, suggesting stability of RNA transcripts at PMIs up to 12 hours. Different library preparation methods (mRNA poly-A capture vs. rRNA depletion) resulted in similar quality metrics with both library preparations achieving &gt;95% of reads properly aligning to the reference genomes across all PMIs for bovine and human hearts. PMI had no effect on RNA Integrity Number or quantity of RNA recovered at the time points evaluated. Of the metabolites identified (855 total) using untargeted metabolomics of human left ventricular tissue, 503 metabolites remained stable across PMIs (0, 4, 8, 12 hours). Most metabolic pathways retained several stable metabolites. Conclusions: Our data demonstrate a technically rigorous, feasible and reproducible protocol that will enhance cardiac biobanking practices and facilitate novel insights into human CVD through the use of multiomics in postmortem human cardiac tissue.
Abstract 13359: Added Benefit of Parametric Mapping in Anthracycline-Induced Cardiomyopathy - Avoiding a Misdiagnosis
Authors: Rimmy Garg, Pablo Barzallo, Juan Del Cid Fratti, Chetan Bhardwaj, Vijayasree Paleru
Journal: Circulation (2022)

Case Presentation A 72 year old man presented with progressive dyspnea on exertion, only able to climb 4 stairs prior to symptom onset. He had a history of diffuse large B-cell lymphoma for which he had completed chemotherapy with cyclophosphamide, doxorubicin, rituximab, vincristine, and prednisone a year prior to presentation with recent PET scan showing complete remission. EKG showed rate-controlled atrial fibrillation. TTE confirmed a severely reduced systolic function with LVEF 25% and global hypokinesis. Coronary angiogram revealed no obstructive disease. Cardiac MRI (CMR) was then performed with no evidence of myocardial infarction, infiltration, or scarring on delayed gadolinium enhancement (DGE). T2 mapping, DIR, and TIR sequencing did not show any myocardial edema. However, baseline pre-contrast T1 relaxation time was increased at 1140-1153ms [Figure 1A] with a calculated ECV [Figure 1B] elevated at 37-40%, concerning for anthracycline-induced cardiomyopathy (AIC). Discussion Anthracyclines, such as doxorubicin, are important chemotherapeutic agents; however, their utility is often limited by development of progressive cardiotoxicity. Cumulative dose-dependent exposure can lead to apoptotic myocyte loss, myocardial fibrosis, and dysmotility. DGE usually identifies focal myocardial fibrosis; however, anthracycline-induced fibrosis is frequently diffuse and can be missed by qualitative analysis and DGE burden assessment. Diffuse fibrosis is better demonstrated with use of hematocrit adjusted ECV and pre-/post-T1 mapping. CMR provides additional information about decrease in the LV mass, aortic stiffness, myocardial strain, early fibrosis detection, and myocardial edema that can aid in early detection of cardiotoxicity during anthracycline therapy. Use of CMR parametric imaging is complementary and essential in accurately diagnosing AIC in patients with prior exposure and merits widespread consideration in cardio-oncology.
Abstract 13592: Gender Related Divergences in Cardiac and Vascular Function With Age
Authors: Tiffany L Brazile, James P Macnamara, Graeme Carrick-Ranson, Erin J Howden, Benjamin D Levine, Satyam Sarma
Journal: Circulation (2022)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a disease of advanced aging that disproportionately affects women. Diastolic function changes with age and it is unknown if gender-related differences in progression exist. Understanding ages at which parameters of vascular and diastolic function diverge may provide insight into the differential risk of HFpEF between genders. Methods: Sedentary but healthy non-obese subjects aged 20-90 (n=178, 58% female; avg age 56 ± 13 yrs) underwent measures of pulmonary capillary wedge pressure (PCWP; right heart catheterization), blood pressure and cardiac output (acetylene rebreathe). Diastolic function was assessed by Doppler echocardiogram. A generalized linear model was used to estimate effects of age for each measured hemodynamic parameter as a function of gender. Results: Across age, women had higher systolic blood pressure (SBP) (age*gender p=0.025, age p&lt;0.001) and total peripheral resistance (TPR) (age*gender p=0.053, age p&lt;0.001). Changes in TPR were apparent at age 26 while SBP diverged at age 55. (Figure) Women had slower early diastolic recoil (e’) (age*gender p&lt;0.001) starting at age 55. While E wave velocity was lower in women, age-related decline was similar to men. E/e’ was higher in women (age*gender p=0.007) and diverged at a young age (28). PCWP declined with age similarly in both men and women. Systolic velocity (s’) declined in early middle age (42) in women (age*gender p=0.007, age p=0.002). Conclusions: Women experience greater changes in cardiac and vascular function with age than men. The age at which these parameters diverge differs, with evidence for decline in vascular function and cardiac contractility occurring at young ages in women while changes in SBP and diastolic recoil occur after age 55. Understanding lifestyle and hormonal factors that influence these differences may help elucidate HFpEF risk factors that are modifiable and serve as a target for therapy.
Abstract 14220: Incidence of Delirium After Transcatheter Aortic Valve Replacement
Authors: Miguel A Martillo, Bertrand Ebner, Ian Ergui, michael Albosta, Michael Dangl, Karla Inestroza, Jelani Grant, Louis T Vincent, Jennifer Maning, Rosario Colombo
Journal: Circulation (2022)

Introduction: Patients who undergo transcatheter aortic valve replacement (TAVR) often are elderly, frail and with comorbid conditions. Delirium is frequently encountered in older adults and is associated with increased morbidity and mortality. Hypothesis: The purpose of this study is to determine the clinical significance of postoperative delirium in patients with aortic stenosis undergoing TAVR. Methods: The National Inpatient Sample was queried from 2011-2019 for relevant ICD-9 and ICD-10 codes to identify patients who underwent TAVR. Baseline characteristics and in-hospital outcomes between patients with and without delirium were compared. Logistic regression was performed to adjust for pre-specified co-variates for mortality and other in-hospital outcomes. p-value was considered significant when &lt;0.001. Results: We identified a weighted sample of 270,178 patients who underwent TAVR, of which 5,059 (1.9%) had a diagnosis of delirium. Baseline characteristics are shown in Table 1. Patients who had delirium after TAVR had a higher mortality risk (3% vs 1.8%), had a longer LOS (median 7 vs 3 days) and higher expenditures (median $220,046 vs $179,166, p&lt;0.001 for all). When adjusted for significant comorbidities, the odds ratio (OR) for mortality was 1.303 (CI [1.1-1.5]) with a LOS OR of 1.065 (CI [1.062-1.068], p&lt;0.001 for both. Conclusions: Delirium after TAVR is associated with higher in-hospital mortality, prolonged hospital stay and higher hospital expenditures. A structured approach focused on prevention and early recognition of delirium may be warranted.
Abstract 13034: Reduction in Cardiovascular Disease Mortality Rates in Brazil is Heterogeneous Across Municipalities: Estimates From the Global Burden of Disease Study, 2000-2018
Authors: Luisa C Brant, Juliana B Souza, Bruno R Nascimento, Antonio L Ribeiro, Deborah C Malta
Journal: Circulation (2022)

Introduction: Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) decreased in Brazil in the last decades due to better control of risk factors and access to treatment. However, how this reduction distributes across the country’s municipalities is not known, which is important due to the socioeconomic and healthcare disparities in its regions (Northern regions being the most vulnerable) and in municipalities with small vs. large populations. Methods: Ecological study in which the ASMR for CVD were estimated by the Global Burden of Disease (GBD) method for 5,568 Brazilian municipalities from the 5 regions in the triennials: 2000-2002, 2009-2011, and 2016-2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were then stratified by population size in &lt;30,000, 30,000-300,000, and &gt;300,000 inhabitants per region, and the % changes in ASMR from 2000-2002 to 2016-2018 were calculated. Results: In 2000-2002, ASMR for CVD were higher in the more developed regions and in the larger municipalities of all regions, except the South. In 2016-2018, CVD ASMR became higher in the least developed Northern regions ( Fig 1 ). Moreover the % reduction in CVD ASMR were lower in small vs. large municipalities within all 5 regions varying from -7% in the small North municipalities to -78% in the large South municipalities. Conclusions: Reduction in CVD mortality in Brazil was lower in the municipalities from the most vulnerable regions and in those with smaller populations. Public policies focusing and tailored to these smaller municipalities, particularly of the least developed regions must be considered a priority.
Abstract 13787: Characteristics and Occupational Trends of Military Tactical Athletes With Repeat Atrial Fibrillation Catheter Ablations
Authors: Andrew Wilson, Andrea Keithler, Matthew Tunzi, Richard E Tomlinson, Kelvin Bush
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) ablation for military personnel aims to provide therapeutic endpoints, recognizing that a subset of personnel require repeat ablation. Objective: This study aims to identify differences in characteristics and occupations of military members who received single versus repeat AF ablation. Further, we aim to understand the rates retention and deployment in those with single versus repeat AF ablation. Hypothesis: We hypothesize that there are increased rates of AF repeat ablations in personnel with risk factors for AF recurrence. Methods: Military personnel who underwent elective AF ablation between 2004 to 2019 were reviewed. Characteristics and military dispositions of personnel with repeated AF ablations were compared to those without. Results: 27 of 104 (26%) personnel received repeat AF catheter ablations on average 16.1±31 months after first ablation. There were no differences between age (34.5+9.5 vs 37.6+9.8 years, P=0.13), BMI (28.1±3.9 vs 28.7±3.4 kg/m2, P=0.48), presence of diastolic dysfunction (11.7% vs 7.4%, P=0.53), left atrial appendage emptying velocities (58.4+22 vs 59.7+23 cm/s, P=0.82), left atrial volume index (29.4+9.9 vs 29.6+8.8 ml/m2, P=0.87), left ventricular ejection fraction (60.4+6% vs 58.5+13%, P=0.31), CHA2DS2-VASc scores (0.37+0.6 vs 0.44+0.7, P=0.60) between those who received a single versus repeated AF ablation. Aviators (40%, 4/10) and healthcare workers (35%, 12/34) underwent repeated ablation at significantly increased rates when compared to 22% of administrators (4/18) and 10% of industrial workers (2/20), (P=0.032). Military retention rates were preserved in those requiring repeated ablation compared to those with single AF ablation (70%, 19/27 vs 78%, 60/77; P=0.60). Deployment rates were statistically similar between those requiring repeated AF ablation compared to single ablation (37%, 10/27 vs 43%, 33/77; P=0.43). Conclusions: Repeat AF catheter ablation rates in military tactical athletes may be driven by specific and individual occupational demands without increased traditional risk factors for AF recurrence. Military retention and deployment rates are preserved for those requiring repeated AF ablation compared to those with single ablation.
Abstract 14896: A Study of the Relationship Between Big Five Personality Traits, Ultra-Processed Diet, and Obesity, and Implications for Cardiovascular Disease
Authors: Maria Balhara
Journal: Circulation (2022)

Introduction: The incidence of cardiovascular events is progressively higher with ultra-processed food consumption. With 7.5, 13, and 18 weekly servings, cardiovascular disease incidence is 8.1%, 12.2%, and 16.6% (Kouvari, 2021). However, the relationship between Ultra-processed Foods and Big Five personality traits in adolescents is understudied, despite ultra-processed foods now making up over 67% of adolescents' diets (Wang, 2021). Methods: The study collected the data for 342 participants aged 14-19 years in Florida, US. Consumption of ultra-processed food intake was calculated using a combined PIE score (Processed Intake Evaluation score, scale 0-100) averaged for different ultra-processed foods. Additionally, we collected data for each participant on personality domains using the Big-5 Inventory (Rammstedt, 2007). Results: The mean age of participants was 16.4±0.9 years, with 53% females. The participants’ personality was assessed on five dimensions- Neuroticism, Agreeableness, Conscientiousness, Extraversion, and Openness to new experiences. The ultra-processed food intake did not significantly differ between participants on Neuroticism and Extraversion dimensions and was elevated in high Conscientiousness participants characterized as hardworking and diligent (49.9 vs. 40.6, p&lt;0.01) possibly due to the perceived convenience of ultra-processed food. A significantly lower intake of processed food was associated with participants who demonstrated high Agreeableness, characterized by a willingness to cooperate, empathize, and share (45.3 vs. 52.1, p&lt;0.01). Also, participants with high Openness to New Experiences, characterized by curiosity, creativity, and a range of interests, were significantly less likely to consume ultra-processed foods (43.8 versus 50.1, p&lt;0.01). Conclusion: Based on these results, Big Five personality constructs are significantly associated with adolescents' ultra-processed food intake. These findings support the inclusion of Openness and other Big Five personality factors in interventions aiming to curb obesity and ultra-processed food consumption among adolescents to mitigate risk factors and reduce the burden of cardiovascular disease.
Abstract 12796: An Unusual Case of Rapidly Progressive Severe Bioprosthetic Aortic Valve Stenosis: A Valve-In Valve Tavr Experience
Authors: Alejandro Sanchez-Nadales, Muftawu-Deen Iddrisu, Dipan Uppal, Antonio Lewis, Gian M Novaro
Journal: Circulation (2022)

Case Presentation 69-year-old male with chronic HFrEF and VHD secondary to infective endocarditis in 1981; severe AR with SAVR in 2016 (Bioprosthetic Edwards Perimount size #25) who presented with worsening shortness of breath. Initial assessment with hypotension and crescendo-decrescendo holosystolic murmur (Grade V/VI). Shortly after admission, he had one episode of pulseless monomorphic VT. Laboratory showed NT Pro-BNP at 2,780 pg/mL. TTE: LVEF of 25% and severe AS (peak gradient 75 mmHg, mean gradient 47 mmHg, and dimensionless valve index: 0.16 cm/m 2 ) (A). TEE confirmed severity of AS caused by prosthetic valve thickening and calcification (B-C). A post-SAVR TTE in 2017 showed normal EF and valve gradients. Right heart catheterization was significant for a peak gradient: 61 mmHg, mean gradient: 45 mmHg, and aortic valve area of 0.59 cm 2 . After multidisciplinary evaluation our patient underwent a valve-in-valve (ViV) TAVR (Evolut Pro Plus prosthetic valve, size #29) and ICD implantation for secondary prevention. Post-procedure TTE showed normal bioprosthetic valve function with dimensionless valve index of 0.4 cm/m 2 . Rest of hospital stay was uneventful with rapid resolution of symptoms Discussion Prosthetic valve restenosis is a common complication of aortic valve repair but this is expected to develop at around 10-15 years following implant, early bioprostetic valve dysfunction is commonly related to valve thrombosis, in this case a TEE and pre-operative CT failed to showed findings of thrombosis. Patient was deemed high risk for a repeat SAVR based on comorbidities and hemodynamic instability at presentation (STS risk stratification: 7.4% risk of mortality). A ViV TAVR was considered as a viable option, with a pre-procedural gated CTA showing favorable valve morphology (D)
Abstract 12791: Examining the Association Between Socioeconomic Factors and Left Ventricular Ejection Fraction Declines in Breast Cancer and Lymphoma Survivors Receiving Doxorubicin: WF-98213
Authors: Arnethea L Sutton, Nathaniel S O'Connell, Alexander R Lucas, Robert L Franco, Kerryn W Reding, Youngdeok Kim, Richard Cheng, Vanessa B Sheppard, Kathryn E Weaver, Glenn J Lesser, William G Hundley
Journal: Circulation (2022)

Introduction: Breast cancer and lymphoma survivors who have received doxorubicin are at risk of experiencing a decline in left ventricular ejection fraction (LVEF), yet whether socioeconomic factors further impact this decline is unknown. Methods: We performed a secondary analysis of data from a double-blinded clinical trial (NCT01988571) in breast cancer and lymphoma survivors that determined the impact of statin use on LVEF 6- and 24-months following initiation of doxorubicin. LVEF was measured via magnetic resonance imaging. Socioeconomic factors were collected via survey. Linear regression models assessed relationships between socioeconomic variables and change in LVEF from baseline to 24 months by individuals blinded to treatment group. Results: Of the 279 survivors included in this analysis, a majority were white (82.8%) (13.6% Black, 3.6% other races), college educated (56.3%), and employed (63.8%). Mean LVEF at baseline was 62.2% (SD=6.01) and mean LVEF declines at 6- and 24-months were 4.72% (SD=7.30) and 5.11% (SD=7.20), respectively. In the multivariable model, after controlling for age, race, body mass index, and smoking, patients who made &gt;$75k per year had a significantly smaller LVEF drop (3.36, 95% CI: -0.53, 7.25) at 6-months than patients making less than &lt;$35k per year (8.66, 95% CI: 4.87, 12.45), p =0.003. Employed patients making &gt;$75k per year had significantly smaller LVEF declines (mean=5.00, 95% CI: 0.14, 9.86) than employed patients making less than 35k per year (mean=9.43, 95% CI: 4.30, 14.56), p=0.033. Lastly, employed patients making &gt;75k had a marginally significantly lower EF drop than unemployed patients making &gt;75k per year (mean=7.83, 95%CI: 3.32, 12.34), p=0.092. These findings occurred independent of statin use. Conclusions: Findings from this study highlight a need to understand how one’s socioeconomic status (SES), or in terms of social determinants of health, economic stability, may serve as a protective factor regarding LVEF decline during treatment with doxorubicin for breast cancer and lymphoma. Future work should also consider examining the association between SES and care delivery and how that may potentially impact LVEF decline.
Abstract 13155: Apelin and Apela for Therapy of Myocardial Fibrosis and Heart Failure
Authors: Anna Kemppi, Lea M Rahtu-Korpela, Zoltan Szabo, Sami Raatikainen, Andrey Anisimov, Kari K Alitalo, Johanna Magga, Risto Kerkela
Journal: Circulation (2022)

The apelin/apela – apelin receptor system regulates a variety of physiological cardiovascular functions including vascular tone, cardiac contractility, angiogenesis, and energy metabolism. However, the cell type specific effects of apelin/apela in the cardiovascular system are not well understood. The aim of this study was to investigate the potential role of apelin and apela in regulating development of myocardial fibrosis and to identify the signaling mechanisms underlying the anti-fibrotic effects. To investigate the role of apelin and apela in vivo , 2-month-old C57BL/6N male mice were injected with AAV9.LacZ, AAV9.Apelin or AAV9.Apela and subjected to thoracic aortic constriction (TAC) for 6 weeks. Echocardiography analysis at the end of the study showed that overexpression of either apelin or apela attenuated TAC-induced left ventricular (LV) dysfunction and increase in LV mass. Analysis of cardiac tissue showed downregulation of collagen I and fibrosis related periostin mRNA expression levels and reduced accumulation of interstitial fibrosis in the left ventricles of mice overexpressing apelin or apela. Studies in human cardiac fibroblasts in vitro showed that apelin and apela attenuate TGFβ1-induced collagen expression and secretion. Analyses of LV tissue and human fibroblast samples indicated that apelin and apela regulate the stress-induced activation of MAPK pathways. Chemical inhibitors and genetic modification of specific signaling elements identified p38 MAPK as a central signaling pathway mediating the inhibitory effect of apelin and apela on TGFβ1 signaling and TGFβ1-induced collagen production. In summary, we show that apelin and apela attenuate hemodynamic pressure overload -induced LV dysfunction and myocardial fibrosis and identify a novel signaling mechanism regulating the response. Our data suggests that activation of apelinergic signaling could offer a novel therapeutic approach to prevent the development of cardiac fibrosis and heart failure.